January 5, 2006

Paying Attention with Play Attention

Posted by Zack Lynch

In this month's Neurotech Insights we focused on the Attention markets. The following is a product review I did on a computer based "neurofeedback" software solution targeted at kids who are "attention challenged."

As the market for ADHD medication continues to grow, non-drug alternatives to treat less severe cases are emerging in the form of neurofeedback systems and less sophisticated computer games. Given the growing interest in non-drug treatment options for ADHD, we contacted the manufacturer of Play Attention, Unique Logic and Technology to take a test drive.

Play Attention is a computer game that uses brain waves, to move objects on a computer screen. Repetitive use of the training system is meant to improve attention, focus, and memory skills for children and others with ADHD, though people who are not “attention challenged” (as the company likes to put it), will also see improvement in their game performance.

Using technology originally developed to help pilots stay alert, the system utilizes a bike helmet lined with sensors connected to a computer. There are 5 games designed to improve different aspects of attention including attention stamina, visual tracking and discrimination of important vs. unimportant stimuli, and short term memory processing.

In the first game, the player must concentrate and stop fidgeting to make an action occur on the screen. If they are concentrating on the object (or a homework assignment), an object, like a UFO or bird, will move in a positive direction and collect power pellets, if they are not concentrating hard enough then the object will move in the opposite direction. For example, the bird will fly higher or descend depending on the level of player concentration.

As the student watches the screen, she learns to regulate her concentration in response to visual feedback from the computer. Results are measured as % of time on task and sessions last about ½ hour twice a week. The company spokesperson said that commonly a student will go from 50% of time on task for 5 minutes to around 80% time on task for after 12 hours of use. After 40-60 hours usually a student can stop using the system.

While our experience proved that a player would certainly get better at the game, it is difficult to tell in our short testing period whether this would translate into real life improvements. A noninvasive, no side effect treatment seems like a good first line option even if the efficacy or patient response rate is less than ideal. However, training games and feedback generally take a back seat to pharmaceuticals and will continue to do so, most likely because of the time to therapeutic impact. While medication, like Ritalin (methylphenidate) can improve symptoms in minutes, gaming can take months to years to show significant improvements, according to Dr. Leann Lesperance and Henry Bernstein of the Harvard Medical School.

According to their analysis, the “Play Attention system may improve symptoms in some children, but it may not help everyone. Although medications can help manage ADHD, there is no cure. You can expect continued research into the causes and treatments of ADHD. While the technology behind this system has been studied in pilots, it apparently has not been extensively studied in children with ADHD. Although preliminary findings seem encouraging, expect that researchers will continue to study its effectiveness.”

Other companies are also working to develop and sell neuroscience based computer games and neurofeedback systems. CyberLearning and Imagine Neuro Solutions sell competitive systems for improving attention, while Posit, Scientific Learning (SCIL), and Wild Devine, are developing training systems for “mental sharpness”, dyslexia, and emotional well being respectively. While the idea of a non FDA regulated, no side effect treatment is intriguing, most of these companies are still proving out their business models.

Play Attention has been on the market since 1996 and is currently being used in over 450 schools. The product has good features for coaching, performance tracking, and includes a module called “academic bridge” designed to translate the game performance to other tasks like homework.. Play attention is priced at $395. For more information, visit www.playattention.com.

I am a neurotherapist practicing in Greenville, South Carolina and am familiar with the Play Attention device. I need to offer a caviat on any device that claims to aleviate ADHD symptoms without first looking at how the person's brain functions. I have investigated Play Attention and it appears as though it has a generic training component to ADHD (training without first looking at brain function). There are 6 different types of ADHD and only by looking at the electrical activity of the brain or at blood flow can one determine the type of ADHD and which part of the brain should be trained. Overtraining sites can also be problematic. It is best to find a professional that is BCIA certified or in the process of being BCIA to train those with ADHD through neurofeedback. Even this method is not effective 100% of the time. However, neurofeedback has been shown to be effective around 85% of the time. A new fMRI study shows that neurofeedback does change brain function.
Jane Price
jprice@sterlingworthcenter.com

In response to neurotherapist Price's comments on Play Attention, I must say they are rather uninformed. I've been on Play Attention's staff since the company's inception. Play Attention is not marketed as a biofeedback or neurofeedback tool. It does utilize feedback to gain attention, but it teaches cognitive skills typically deficit in persons with attention problems. We have found that changing brainwaves does not precipitate behavioral change, i.e. changing brainwaves does not mean that Johnny will finish his homework. Finishing homework (task closure or time on-task) is a skill that must be learned and cannot be obtained through osmosis or neurofeedback alone. Unfortunately, comments like Ms. Price's are indicative of the state of neurofeedback bordering on pseudoscience and phrenology. For example, citing that there are six types of ADHD - is ludicrous. True, some independent fMRI studies have found differences, but it seems, without virtually any peer review, data is published saying the miraculous fMRI and CAT scans now identify many types of ADHD and Schizophrenia and a variety of other brain disorders. The National Institutes of Health also don't identify six types of ADHD. They identify three. Perhaps they just aren't up to speed on this miraculous new scanning technology, but word in the field is, it's nascent, not proven, and a good way to spend money without result. Secondly, Ms. Price's comment on overtraining sites is ridiculous, but again indicative of the lack of knowledge about neurofeedback training that tends to permeate the industry pushing it to the realm of pseudoscience. A three sensor system typically used for attention training does NOT operantly condition sites in the brain. Nor are they able to obtain specific data from sites over which the sensors are placed. This would entail the brain firing a discrete column of energy from the location under the sensor to the sensor. That doesn't happen. There is no known physics to support this since brainwaves are received from a field of energy. Thus, site placement is but a myth that will keep neurofeedback in the dark ages a bit longer. Our colleagues at both NASA and MIT agree. Finally saying that fMRI studies show brainwave change is another bit of misinformation. Do fMRI pictures of brainwave change tell us that we'll be able to stay focused enough to balance our checkbook? Finish homework? Chunk more in short-term memory? No. Only behavioral outcomes will indicate this. That's what we strive for at Play Attention. It's a tremendous teaching tool. We don't monitor brainwaves. We monitor outcomes. Behavioral outcomes. I typically don't write in response to inane comments, but Ms. Price typifies this field -- it's in the dark ages and won't move forward until the myths about neurofeedback are put to rest.

Unfortunately, your the one that seems to be uninformed. You are putting more faith in NASA "agreeing" with your gimick play attention thing than a whole field of neuroscience that specializes in the activity of the brain. A lot of your claims are biased unscientifically backed assertions. Hmm, lets see what you say here: "Do fMRI pictures of brainwave change tell us that we'll be able to stay focused enough to balance our checkbook? Finish homework? Chunk more in short-term memory? No. Only behavioral outcomes will indicate this".....so your claiming that neurofeedback training, which usually involves a person monitoring the neuronal growth process with an EEG to acheive an ideal brain activity(based on the individual) is not looking at behavioral outcomes? I mean, maybe you should think twice before you type something that obviously doesn't even make sense. And your also telling me that if you put on a helmet with 3 sensors and look at a computer screen it will teach you how to balance your checkbook and finish your homework? Oh wait, and to add to this magic, there is someone who you can contact on the phone who is a "masters level advisor"(Whatever the hell that means)...Is the key to doing everyday life things reaching this magical new scientific realm of measuring "behavioral outcomes"....Listen, you can't enter into a realm of neuroscience and completely discount neuroscience itself, you just won't get anywhere...Do yourself a favor, pick up some neuroscience books, go to a scholar academic search site and type in neurofeedback results... Then you will see studies done by the top research institutions for medicine (such as harvard, vanderbilt). Good luck with that

There is a recently launched weblog, BrainWaves, being written by Zach Lynch of Neuroinsights that is becoming a “must read.” He is clearly following my policy of only writing about things that he has checked out himself. There is a [Read More]